CHICAGO—As providers prepare for a fight against surprise medical billing policy, imaging experts offered their advice for advocacy success during RSNA’s annual meeting Monday.
Radiology Partners’ Richard Heller, MD, shared the example of a recent spat with health insurer Anthem over a payment restriction that steered patients age 10 and up away from hospitals toward cheaper imaging sites. Anthem enacted the policy in 2017 with insurers Cigna and UnitedHealthcare later following suit.
But after fierce opposition—arguing pediatric patients require specialized imaging services available in hospitals—each subsequently relented, with Anthem the last to cave in August. Radiology advocates notched another win in September, as Aetna launched its own site-of-care payment restrictions that avoided the controversy.
“When they announced their policy, they left out pediatrics,” Heller, who is Rad Partners’ associate chief medical officer in communications and health policy, told attendees on Nov. 29. “This was a battle that we won that we never had to fight because we won those other battles.”
Heller shared four lessons learned from the effort, which radiologists can use in their own advocacy:
1. Coordinated approach: Those involved made sure to make the issue clear and understandable to others.
2. Allies, allies, allies: He said the effort would not have been successful without numerous allies writing letters and keeping the pressure on payers. Those included the American College of Radiology, the Society for Pediatric Radiology and American Medical Association and others.
“Finding allies was key to advocacy,” he said.
3. Persistence pays off: Heller said the win was “years in the making” as Anthem first announced its restrictions back in 2017 and didn’t relent until August of 2021.
4. Momentum matters: While Anthem was the first to launch such a policy, it was the last to finally roll it back. Heller believes the momentum of others dropping their policies and additional medical societies joining the campaign finally led to the insurer caving.
“If you’re passionate on an issue, speak up. Be the squeaky wheel. This issue was taken care of because physicians stood up,” he concluded.
Sarah Avery, MD, the incoming president of the Texas Radiological Society, offered her own advice after the group successfully lobbied for a breast density notification law in the state. She too emphasized the need for persistence while also urging others to seek financial support, with the society hiring a lobbyist to help see the issue through. Partnering with other stakeholders is also crucial, she added.
“It really does amplify the voice,” she told attendees. “We found in Texas that the legislators pay more attention to any topic where the house of medicine can agree and not differ in terms of their opinion.”
Heller sees an ongoing dispute over provisions in the No Surprises Act as the next big advocacy issue for the radiology community. He’s slated to speak on the topic at RSNA on Thursday and urged others to get involved in addressing this issue.
“Advocacy will be crucial to protecting medical practices and their patients from the recent interim final rule on arbitration,” he said after the session. “Disrupting good-faith negotiations between insurance companies and doctors and pushing practices and patients out of network is antithetical to the spirit of the law, and as the chair and ranking member of the House Ways & Means Committee stated, violates congressional intent. This is the time for us to make our collective voices heard.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.